In the final days of Roe v. Wade, my one consolation may be the fact that none of the people currently passing laws about the human uterus actually know how it works. Consider: According to one recent finding, “40 percent of Republican men voters say it’s ‘true’ or are not sure whether ‘most women get their periods at the first of the month.’” Consider: Hannah Smothers’s reporting for Cosmopolitan on the LEEP, a “routine” gynecological procedure to remove irregular cervical cells, which occasionally has the somewhat extreme side effect of making it impossible for the patient to orgasm. Research suggests LEEPs can damage or cut cervical nerves, numbing the entire area; doctors aren’t taught how to avoid those nerves, and patients are not warned before undergoing the procedure.

In a world where you can get a Pulitzer for mood-ring boobs, how is it surprising that people don’t know enough to be horrified by a six-week abortion ban? If you think every menstruating person on Earth gets their period at the same time as their rent is due, it follows that knowing you’re pregnant should be easy and instant; it would never occur to you that someone’s abortion window might expire before she even realizes she’s missed a period. In a culture where gynecologists aren’t trained on cervical anatomy, it’s not shocking that cardiologists aren’t trained to recognize heart disease symptoms in female and AFAB patients; in one study, 53 percent of women with heart attacks were turned away by their doctors, who told them their symptoms were “not health-related.” A medical establishment that doesn’t know how to care for AFAB bodies inevitably winds up abusing them. Until very recently, it was standard practice for medical students to perform non-consensual pelvic exams—in layman’s terms, sticking their goddamn hands up people’s vaginas—on patients under anesthesia. When I say very recently, I mean very. States just started banning the practice this year.

This isn’t about “women’s” bodies, necessarily, because many of the bodies that fall into this blind spot aren’t women’s; they belong to trans men, or to nonbinary people. Trans women don’t have to worry so much about uterine misconceptions, it’s true, but it would take deep and genuine idiocy to argue that their bodies aren’t also marginalized—pathologized, fetishized, subject to endless, invasive, obsessive scrutiny and then punished for attracting our attention. None of those bodies are well cared for by a medical establishment that mainly aims to serve cis men: In a Catholic hospital, a trans man who needs a hysterectomy is no safer than a cis woman who needs an abortion. The probable fall of Roe v. Wade coincides with the Trump administration’s efforts to make it legal for doctors and hospitals to discriminate against trans patients of any gender. What it’s about is the cruelty of life outside the cis, male default; the danger people are forced to live in when our definition of “human” is constructed without them, or in spite of them, cutting against the grain of their experience.

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What it’s about is the cruelty of life outside the cis, male default; the danger people are forced to live in when our definition of “human” is constructed without them, or in spite of them, cutting against the grain of their experience.

Disgust for these bodies is, of course, key to how misogyny and transphobia work. Donald Trump, for example, accuses women who dislike him of being possessed by irrational, menstrual fury, and calls lactating women “disgusting.” His contempt for those bodies can’t be separated from his desire to conquer them, all the pussy-grabbing and changing-room rapes he’s admitted to or been accused of. But this isn’t always about anger. It’s about a quiet, pervasive refusal to listen—a refusal to acknowledge that women and trans people could ever be authorities on life inside their own bodies.

In Smothers’s article, we hear from “Sasha,” who tried to tell her doctors about her post-LEEP sexual dysfunction and was repeatedly referred to psychiatrists and therapists. She had to demand a proper examination for ten years before someone finally diagnosed her nerve damage. Doctors routinely underrate women’s pain levels. Women in agony—like Rachel Fassler, who reported to the ER with ovarian torsion leading to organ failure—have been made to wait in emergency rooms for hours, simply because hospital staff assumed they were exaggerating. All those women whose heart attack symptoms were missed by their doctors weren’t just turned away, they were called crazy first; cardiologist Dr. Nieca Goldberg, who specializes in women’s heart disease, told the Huffington Post that it was common for her male peers to tell women with cardiac symptoms that they were “just stressed.” In fact, the more we associate an illness with women, the more likely we are to dismiss it as psychosomatic; throughout history, doctors have denied the existence of fibromyalgia, menstrual cramps, or even post-traumatic stress from sexual assault, which is what many 19th-century “hysterics” would likely be diagnosed with today.

This is the invisibility that precedes violence; if you’ve already come up with a “scientific” reason to dismiss someone’s pain, then it becomes very easy to hurt them and not feel bad about it. Non-consensual pelvic exams are used in some states to punish abortion patients; it’s cruel, but it’s also a logical progression for a medical establishment that already uses sexual assault as a training tool. Forcing someone through the physical danger of pregnancy, or the agony of childbirth, is much easier if you don’t really believe they experience pain. Gender dysphoria can be written off as one more “exaggeration,” one more way people lie about pain that doesn’t exist. It’s pretty hard to argue that we live in a culture that values women’s sexual autonomy when you know gynecologists aren’t warned that they may break their patients’ clits.

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It’s hard to know how to break through any of this, or change it — the whole point is that, if you correct the authorities, they will refuse to listen — but to understand the state of play is, as I say, a kind of consolation. To know that we’re fighting for our humanity, not in some abstract way, but in the very real sense of having to insist that our bodies are real, and have real people inside them. Most of us live our lives at the mercy of some kind of authority, subject to someone else’s definitions, but the thing to know, about the people making those definitions, is not just that they’re harmful — they don’t understand what they’re talking about or who they’re describing. It is some hope to know that definitions change over time. The more we speak about what it is to be in our own skins, the more the world will have to listen.

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About the Author

Sady Doyle is the author of 'Dead Blondes and Dead Mothers' (2019) and 'Trainwreck: The Women We Love to Hate, Mock, and Fear... and Why' (2016), both published by Melville House. Doyle also founded the feminist blog Tiger Beatdown, and has been a staff writer at In These Times Magazine and Rookie Magazine and contributed several pieces to the bestselling Book of Jezebel. Her work appears regularly at Elle.com, QZ, and more.